Author + information
- Manu Kaushik,
- Alok Saurav,
- Satish Chandraprakasam,
- Anand Deshmukh,
- Michael Del Core,
- Aryan Mooss and
- Dennis Esterbrooks
While, proximal right coronary artery (RCA) occlusion in patients with inferior STEMI would suggest right ventricular involvement, the effect of location of RCA occlusion on outcomes has not been studied. We sought to evaluate the impact of site of occlusion of RCA on outcomes of patients with inferior STEMI undergoing PCI.
All patients presenting to a tertiary care center between June 2006 and May 2012 with STEMI and undergoing PCI with RCA as the culprit vessel were included. Patients with proximal RCA occlusion were compared to patients with distal RCA occlusion. Lesion location was determined based on whether the occlusion was proximal or distal to major right ventricular branch take-off. Patients with posterior descending branch or posterolateral branch occlusion were excluded to correct for left ventricular myocardium at risk in both comparison groups. Clinical and outcome variables were retrieved from retrospective chart review.
One hundred, ninety-seven patients were included in final analysis of which, 94 patients had proximal RCA and 103 had distal RCA occlusion. There were no significant differences between the two groups with respect to gender, prevalence of hypertension, hyperlipidemia (HL), diabetes mellitus (DM), smoking, chronic pulmonary disease and timely revascularization. Twenty-four patients were treated with PTCA, while 173 patients were treated with stenting. Major adverse cardiovascular events (MACE) defined as combined incidence of cardiogenic shock, IABP use, cardiac arrest and death was similar in the two groups (21.3% vs. 18.4%; p <0.05). Individual event rates for cardiogenic shock, IABP use, death, cardiogenic shock and hypotension were also statistically similar in both groups. Post STEMI left ventricular function was similar in both groups (46.8 vs 47.2%; p = 0.77) as was the duration of hospitalization (5.06 vs. 5.17 days; p = 0.75). No clinical variables (gender, hypertension, DM, smoking, HL, chronic pulmonary disease, etc.) predicted MACE. However, time to revascularization > 6 hours from symptom onset showed a statistical trend towards predicting MACE (OR=0.50 [95% CI 0.24-1.05], p = 0.06).
In patients presenting with inferior STEMI treated with PCI, location of occlusion with respect to the right ventricular branch origin does not predict major adverse cardiovascular events Proximal lesion location in right coronary artery should not be used as a surrogate for clinically significant right ventricular involvement in STEMI patients.
- 2013 American College of Cardiology Foundation